Alliance Medical Corporation Common Stock Certificate

Summary

This document certifies that the named individual is the registered owner of fully paid and nonassessable shares of common stock in Alliance Medical Corporation, a Delaware corporation. The shares are transferable only on the corporation’s books by the holder or an authorized attorney upon proper endorsement and surrender of the certificate. The certificate must be countersigned by the transfer agent to be valid. If lost, a replacement requires a bond or indemnity. The corporation will provide information about stock rights and preferences upon request.

EX-4.1 5 p65358a2ex4-1.txt EX-4.1 Exhibit 4.1 NUMBER [ALLIANCE MEDICAL CORPORATION LOGO] SHARES ALMC CUSIP 018634 10 5 SEE REVERSE FOR CERTAIN DEFINITIONS INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE THIS CERTIFIES THAT is the record holder of FULLY PAID AND NONASSESSABLE SHARES OF COMMON STOCK, $.001 PAR VALUE PER SHARE, OF ALLIANCE MEDICAL CORPORATION transferable only on the books of the Corporation by the holder hereof in person or by duly authorized Attorney upon surrender of this certificate properly endorsed. This certificate is not valid until countersigned by the Transfer Agent and Registrar. WITNESS the facsimile signatures of its duly authorized officers. Dated: [ALLIANCE MEDICAL CORPORATION CORPORATE SEAL] /s/ [Illegible] /s/ [Illegible] CHIEF EXECUTIVE OFFICER AND SECRETARY CHIEF FINANCIAL OFFICER COUNTERSIGNED AND REGISTERED: U.S. STOCK TRANSFER CORPORATION TRANSFER AGENT AND REGISTRAR BY: AUTHORIZED SIGNATURE ALLIANCE MEDICAL CORPORATION THE CORPORATION WILL FURNISH WITHOUT CHARGE TO EACH STOCKHOLDER WHO SO REQUESTS THE POWERS, DESIGNATIONS, PREFERENCES AND RELATIVE PARTICIPATING, OPTIONAL OR OTHER SPECIAL RIGHTS OF EACH CLASS OF STOCK OR SERIES THEREOF AND THE QUALIFICATIONS, LIMITATIONS OR RESTRICTIONS OF SUCH PREFERENCES AND/OR RIGHTS. SUCH REQUEST MUST BE MADE TO THE CORPORATION'S SECRETARY AT THE PRINCIPAL EXECUTIVE OFFICE OF THE CORPORATION. Keep this Certificate in a safe place. If it is lost, stolen or destroyed, the Corporation will require a bond or indemnity as a condition to the issuance of a replacement certificate. The following abbreviations, when used in the inscription on the face of this certificate, shall be construed as though they were written out in full according to applicable laws or regulations: TEN COM - as tenants UNIF GIFT MIN ACT- ____________ Custodian ____________ in common (Cust) (Minor) Under Uniform Gifts to Minors TEN ENT - as tenants by the entireties Act. ________________________________ (State) JT TEN - as joint tenants with UNIF TRF MIN ACT-__________ (Custodian (until age ___) right of (Cust) survivorship and not as ______________under Uniform Transfer tenants in (Minor) common to Minors Act _______________________ (State) Additional abbreviations may also be used though not in the above list. For Value Received, ______________________ hereby sell, assign and transfer unto PLEASE INSERT SOCIAL SECURITY NUMBER OR OTHER IDENTIFYING NUMBER OF ASSIGNEE _____________________________________________ _____________________________________________ ________________________________________________________________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE OF ASSIGNEE(S) ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Shares represented by the within Certificate, and do hereby irrevocably constitute and appoint ________________________________________________ Attorney to transfer the said Shares on the books of the within named Corporation with full power of substitution in the premises. Dated __________________________ _____________________________________________ NOTICE: THE SIGNATURE TO THIS ASSIGNMENT MUST In presence of CORRESPOND WITH THE NAME AS WRITTEN UPON THE FACE OF THE CERTIFICATE IN EVERY PARTICULAR, ________________________________ WITHOUT ALTERATION OR ENLARGEMENT, OR ANY CHANGE WHATEVER. ________________________________ Signature(s) Guaranteed By ____________________________________________________________ THE SIGNATURES MUST BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM) PURSUANT TO S.E.C. RULE 17Ad-16.